Provider Demographics
NPI:1912903766
Name:PARKER, KAREN (FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SHUBUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39360-8870
Mailing Address - Country:US
Mailing Address - Phone:601-687-1391
Mailing Address - Fax:601-687-0051
Practice Address - Street 1:130N HIGH ST
Practice Address - Street 2:
Practice Address - City:SHUBUTA
Practice Address - State:MS
Practice Address - Zip Code:39360-8870
Practice Address - Country:US
Practice Address - Phone:601-687-1391
Practice Address - Fax:601-687-0051
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR669563363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0117790Medicaid
MSS84393Medicare UPIN